Scenario B

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Disaster has struck - hard on the heels of the COVID-19 pandemic, another disease outbreak has hit your fair city, Baltyre. Residents are outraged and worried. There have already been 13 deaths.

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Disaster has struck - hard on the heels of the COVID-19 pandemic, another disease outbreak has hit your fair city, Baltyre. Residents are outraged and worried. There have already been 12 deaths.

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The cause of the outbreak appears to be Influenza A virus. (Please refer to the WHO Influenza Fact Sheet for more information about the pathogen.)

False-coloured transmission electron microscopy (TEM) image of an influenza virus particle. Image credit: [CDC](https://phil.cdc.gov/Details.aspx?pid=10073)

Figure 1: False-coloured transmission electron microscopy (TEM) image of an influenza virus particle. Image credit: CDC

Each member of your group will play one of the following roles as you attempt to tackle the disease outbreak and save your city:

  1. Provost (head of the city council)
  2. Representative from a national public health org. (Public Health Scotland)
  3. Epidemiologist (on secondment from Public Health Scotland)
  4. Director of the city’s main hospital (Queen’s College)
  5. City planner/civil servant
  6. Microbiologist (working in one of the NHS Scotland clinical labs)
  7. Public communications expert (past and current sci comm campaigns)
  8. Doctor at a major surgery in Baltyre
  9. Epidemiologist from the local university, an expert on influenza virus A transmission

You must work together, using the information that has been provided for you in the attached information packets, and decide what action(s) should be taken to control the outbreak currently plaguing your city, Baltyre. Your actions should be evidence-based – use the peer-reviewed literature to decide on measures that will stop the pandemic in your scenario.

Your action points may include directives to gather more information (e.g., contact tracing of current cases, microbiological testing of food/water, etc.), or specific directives (e.g. public health measures, non-pharmaceutical interventions, etc.). Use the data/expertise of all group members. Be clear, concise, and specific.

You may choose to include mathematical modeling as part of your decision making (for example, using an epidemic calculator or other models); if you do so, you should provide details of your modelling and predictions when you submit your group’s pro forma.

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You should submit 3-5 specific actions to control the pandemic, using the workshop 3 pro forma (also available on MyPlace). Submit this by noon, Friday March 1st, via the submission link on MyPlace.

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You should submit 3-5 specific actions to control the pandemic, using the workshop 3 pro forma (also available on MyPlace). Submit this by noon, Friday March 1st, via the submission link on MyPlace.

>>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4

Information Packet B1

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You are the provost of Baltyre, elected in 2015.

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You are the provost of Baltyre, elected in 2021.

>>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4
Photograph of Baltyre city centre. Image credit: DALL-E

Figure 2: Photograph of Baltyre city centre. Image credit: DALL-E

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The current population of Baltyre (as of December 2022) is 155755. The demographic data for the city is shown below.

Baltyre demographics (Source: Office for National Statistics)Baltyre demographics (Source: Office for National Statistics) =======

The current population of Baltyre (as of December 2022) is 155195. The demographic data for the city is shown below.

Baltyre demographics (Source: Office for National Statistics)Baltyre demographics (Source: Office for National Statistics) >>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4

Figure 3: Baltyre demographics (Source: Office for National Statistics)

You were elected as a member of the popular “New Progress” party and made a number of election promises regarding a “Green New Deal” for Baltyre.

<<<<<<< HEAD Voting intention by Baltyre residents (Source: YouGov polling) ======= Voting intention by Baltyre residents (Source: YouGov polling) >>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4

Figure 4: Voting intention by Baltyre residents (Source: YouGov polling)

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There are currently 32 elected councillors, representing the 5 main political parties in Baltyre as follows:

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There are currently 42 elected councillors, representing the 5 main political parties in Baltyre as follows:

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Political Party Number of Seats
Gold <<<<<<< HEAD 1 ======= 2 >>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4
Vocal Action <<<<<<< HEAD 8 ======= 11 >>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4
New Progress <<<<<<< HEAD 16 ======= 20 >>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4
Truth to Power <<<<<<< HEAD 5 ======= 7 >>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4
Social Redistribution 2



<<<<<<< HEAD The overall budget (expenditures) for the 2022-2023 financial year was £423549239. A summary of expeditures by category for this financial year is shown below.

======= The overall budget (expenditures) for the 2022-2023 financial year was £557887191. A summary of expeditures by category for this financial year is shown below.

>>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4
Public expenditures by category for the 2022-2023 financial year (Source: Baltyre City Council)

Figure 5: Public expenditures by category for the 2022-2023 financial year (Source: Baltyre City Council)

Your office has recently received a great deal of correspondence regarding the pandemic in Baltyre. A representative sample of these e-mails is shown below.

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From:
To:
Cc: Subject: This Horrible Pandemic

Dear Provost,

I am devastated to hear about this new pandemic in Baltyre. There seems to be no end to the suffering that pandemics inflict on our city in these days.

I wish that your office is going to do something about tragedy immediately.

Respectfully,
Wilson

From:
=======

From:
To:
Cc: Subject: This Devastating Pandemic

Dear Provost,

I am devastated to hear about this new pandemic in Baltyre. Too many people have died and it is such a tragedy.

I sincerely hope that your office is going to do something about horrible pandemic very soon.

Yours truly,
Su

From:
>>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4 To:
Cc:
Subject: Pandemic Disaster for Businesses

Dear Provost,

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This new pandemic in Baltyre has the potential to destroy our businesses. I run a used bookstore on the high street and almost literally had to close because of all the draconian lockdowns due to COVID.

I hope you realise that you need to put businesses first now - we were unfairly forced to bear the costs of the last pandemic.

I hope that your office is going to do something about dreadful state of affairs at once, keeping in mind the economic interests of businesses in our city and the fact that we cannot afford another lockdown.

Respectfully,
Madison (The Baltyre Shop, proprietor)

From:
To:
Cc:
Subject: New Pandemic Measures

Dear Provost,

I hate the idea that you and your office are going to use this new pandemic as yet another excuse for government overreach into citizens’ lives. I am sick and tired of government interference with my life, I have the right to go about my life without some do-gooder from a public health agency telling me that I need to wear a mask and can’t visit my grandmother.

Facemasks are just the tyranny of the minority over the majority, I hope that you will not permit them again on your watch.

All the best,
Alise (a concerned voter)

From:
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This new pandemic in Baltyre has the potential to crush our businesses. I run a cafe on the high street and almost went bankrupt due to COVID.

I hope you realise that you need to put businesses first now - we were unfairly forced to bear the costs of the last pandemic.

I wish that your office is going to do something about tragedy immediately, keeping in mind the economic interests of businesses in our city and the fact that we cannot afford a return to COVID rules.

Respectfully,
Graham (Around the Corner, proprietor)

From:
To:
Cc:
Subject: Stop This Madness

Dear Provost,

I hate the idea that you and your office are going to use this new pandemic as yet another excuse for government overreach into citizens’ lives. Machiavelli said that power corrupts absolutely, and he was absolutely right - look at what happened during the last pandemic.

I hope that you will do the right thing in this time of crisis and that I will be able to vote for you again in the coming elections with a clean conscience.

Yours sincerely,
Siobhan (a concerned voter)

From:
>>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4 To:
Cc:
Subject:

Dear Provost,

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I have just learned that my my sister-in-law has passed away due to the new pandemic in Baltyre. This is an unspeakable loss.

Words cannot begin to describe our loss.

I really wish that our government had better learned its lessons from the COVID-19 pandemic and could have prevented this terrible tragedy.

Best wishes,
Luke

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I have just learned that my my sister-in-law has passed away due to the new pandemic in Baltyre. This is truly a tragedy.

You cannot begin to imagine the grief that we are feeling.

I really wish that our government had better learned its lessons from the COVID-19 pandemic and could have prevented this terrible tragedy.

Best wishes,
Rodrigo

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As Provost of Baltyre, you are of course familiar with the work of the Standing Committee on Pandemic Preparedness. You are also familiar with:

Information Packet B2

You are a representative from Public Health Scotland, sent to Baltyre to help with the influenza outbreak.

Your briefing packet includes the following documents:

  • Public Health Scotland Influenza A-Z

  • Uyeki, Timothy M et al. “Influenza.” Lancet (London, England) vol. 400,10353 (2022): 693-706.

  • Tyrrell CS, Allen JLY, Gkrania-Klotsas E. Influenza: epidemiology and hospital management. Medicine (Abingdon). 2021 Dec;49(12):797-804. doi: 10.1016/j.mpmed.2021.09.015.

  • Kassianos, George et al. “Implementation of the United Kingdom’s childhood influenza national vaccination programme: A review of clinical impact and lessons learned over six influenza seasons.” Vaccine vol. 38,36 (2020): 5747-5758. doi:10.1016/j.vaccine.2020.06.065

Information Packet B3

You are an epidemiologist working for Public Health Scotland, sent to Baltyre to help with the influenza outbreak.

A team of scientists working together have in a PHS lab have isolated and cultured influenza virus (using a standard tissue culture model) from a number of patient samples taken during this outbreak; isolated influenza RNA from these cultures; reverse-transcribed this to DNA, and sequenced this DNA using an Illumina MiSeq platform; assembled the short paired-end reads; and compared these assemblies to the extant influenza sequences available in the NCBI databases. The results of these experiments are summarised in the table below.

Patient NCBI accession of closest database match to the NA genome segment
1 KU171017.1
2 KU171017.1
3 UZY70773.1
4 KU171017.1
5 KU171017.1
6 UZY70773.1
7 KU171017.1
8 KU171017.1
9 KU171017.1
10 UUB84697.1



Your briefing packet also includes the following documents:

  • Lean, Fabian Z X et al. “Gross pathology of high pathogenicity avian influenza virus H5N1 2021-2022 epizootic in naturally infected birds in the United Kingdom.” One health (Amsterdam, Netherlands) vol. 14 100392. 27 Apr. 2022, doi:10.1016/j.onehlt.2022.100392

  • Wolken, Madeline et al. “Wastewater surveillance of SARS-CoV-2 and influenza in preK-12 schools shows school, community, and citywide infections.” Water research vol. 231 (2023): 119648. doi:10.1016/j.watres.2023.119648

  • Chen, Kuang-Yu et al. “High-throughput droplet-based analysis of influenza A virus genetic reassortment by single-virus RNA sequencing.” Proceedings of the National Academy of Sciences of the United States of America vol. 120,6 (2023): e2211098120. doi:10.1073/pnas.2211098120

  • Smyk, Julia M et al. “Evolution of Influenza Viruses-Drug Resistance, Treatment Options, and Prospects.” International journal of molecular sciences vol. 23,20 12244. 13 Oct. 2022, doi:10.3390/ijms232012244

  • Weekly National Flu Reports (UKHSA)

Information Packet B4

You are the director of Baltyre’s main hospital, the Queen’s College, which has 550 beds across 9 different wards and 10 operating theatres.

The Queen's College hospital in Baltyre. Image credit: [DALL-E

Figure 6: The Queen’s College hospital in Baltyre. Image credit: [DALL-E

The annual operating budget for financial year 2022-2023 was £1.5 million, and average expenditures are shown by category in the figure below.

Hospital expenditures by category for financial year 2022-2023 (Source: NHS Scotland)

Figure 7: Hospital expenditures by category for financial year 2022-2023 (Source: NHS Scotland)

The Queen’s College has units specialising in coronary care; maternity care; dermatology; gastroenterology; an ear, nose, and throat clinic; an eye clinic; and an orthopedic unit.

There are currently 25 ICU beds (with ventilators) available, an increase from the 14 ICU beds in the Queen’s College in November 2019. Average ICU bed occupancy before and during the COVID-19 pandemic is in the figure below.

<<<<<<< HEAD ICU bed occupancy for the Baltyre Queen's College hospital (Source: NHS Scotland) ======= ICU bed occupancy for the Baltyre Queen's College hospital (Source: NHS Scotland) >>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4

Figure 8: ICU bed occupancy for the Baltyre Queen’s College hospital (Source: NHS Scotland)

There are approximately 1.3m admissions to the Queen’s College hospital annually, the majority of these being to the emergency (A&E) department.

Admissions to the Baltyre Queen's College hospital by category (Source: NHS Scotland)

Figure 9: Admissions to the Baltyre Queen’s College hospital by category (Source: NHS Scotland)

A&E waiting times have been called “disastrously high” in recent months, both by the press and by tthe hospital ombudsman.

<<<<<<< HEAD ICU waiting times for the Baltyre Queen's College hospital (Source: NHS Scotland) ======= ICU waiting times for the Baltyre Queen's College hospital (Source: NHS Scotland) >>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4

Figure 10: ICU waiting times for the Baltyre Queen’s College hospital (Source: NHS Scotland)

The Queen’s College has been set a goal of 25% reduction in sepsis mortality (compared to past years)and 50% reduction in the nosocomial transmission of superbugs such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridiodes difficile (C. diff), and Candida auris (C. auris).

Key Performance Indicators (KPIs) related to infectious diseases for the Baltyre Queen's College hospital (Source: NHS Scotland)

Figure 11: Key Performance Indicators (KPIs) related to infectious diseases for the Baltyre Queen’s College hospital (Source: NHS Scotland)

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There are currently 150 patients in the Queen’s College with confirmed or suspected influenza, with 17 of these patients currently in the ICU.

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There are currently 180 patients in the Queen’s College with confirmed or suspected influenza, with 17 of these patients currently in the ICU.

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The hospital follows the guidelines set out in the National Infection Prevention and Control Manual.

As a hospital director, you are familiar with the literature surrounding hospital pandemic preparedness, and regularly read papers such as:

  • Mer, Mervyn et al. “Critical Care Pandemic Preparation: Considerations and Lessons Learned from COVID-19.” Critical care clinics vol. 38,4 (2022): 761-774.

  • Tacconelli, Evelina et al. “Challenges of data sharing in European Covid-19 projects: A learning opportunity for advancing pandemic preparedness and response.” The Lancet regional health. Europe vol. 21 (2022): 100467.

  • Adelaja, I., Sayma, M., Walton, H., McLachlan, G., de Boisanger, J., Bartlett-Pestell, S., Roche, E., Gandhi, V., Wilson, G. J., Brookes, Z., Yeen Fung, C., Macfarlane, H., Navaratnam, A., James, C., Scolding, P., & Sara, H. (2020). A comprehensive hospital agile preparedness (CHAPs) tool for pandemic preparedness, based on the COVID-19 experience. Future healthcare journal, 7(2), 165–168.

Information Packet B5

You are a civil servant working in Baltyre, working closely with the provost, city council and various agencies including the NHS, the UK Health Security Agency (UKHSA), and the Scottish Environment Protection Agency (SEPA).

Some of the key Baltyre facts and figures at a glance are summarized in the table below.

Community Amenities Details
Schools <<<<<<< HEAD 8 primary schools, 5 secondary schools, 1 college ======= 10 primary schools, 4 secondary schools, 1 college >>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4
Care Homes 3, each with ~40 bed capacity
Restaurants and Cafes <<<<<<< HEAD 97 ======= 113 >>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4
Parks and Playgrounds <<<<<<< HEAD 8 ======= 3 >>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4
Economic Indicators Details
GDP/capita <<<<<<< HEAD £39884 ======= £41440 >>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4
Unemployment Rate <<<<<<< HEAD 5% ======= 6% >>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4
Traffic and Transport Details
Traffic fatalities (average/month) <<<<<<< HEAD 13 ======= 7 >>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4



Your briefing packet on influenza includes the following information.

Information Packet B6

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You are a microbiologist working in the virology department at the Greater Baltyre Clinical Laboratory. Your laboratory is equipped to handle a range of culture samples (including anaerobic and microaerobic bacteria, as well as viruses), and you routinely process 1759 samples monthly.

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You are a microbiologist working in the virology department at the Greater Baltyre Clinical Laboratory. Your laboratory is equipped to handle a range of culture samples (including anaerobic and microaerobic bacteria, as well as viruses), and you routinely process 1953 samples monthly.

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You are familiar with the culture requirements for growth of influenza viruses in tissue culture, and the range of influenza virus testing methods.

A plaque assay for influenza virus. Image credit: [CDC](https://phil.cdc.gov/Details.aspx?pid=23215)

Figure 12: A plaque assay for influenza virus. Image credit: CDC

You are also familiar with the literature surrounding influenza virus identification, and often read papers such as:

  • Morehouse, Zachary P et al. “A narrative review of nine commercial point of care influenza tests: an overview of methods, benefits, and drawbacks to rapid influenza diagnostic testing.” Journal of osteopathic medicine vol. 123,1 39-47. 19 Aug. 2022.

  • Ison MG, Hayden FG, Hay AJ, Gubareva LV, Govorkova EA, Takashita E, McKimm-Breschkin JL. Influenza polymerase inhibitor resistance: Assessment of the current state of the art - A report of the isirv Antiviral group. Antiviral Res. 2021 Oct;194:105158.

  • Van Poelvoorde, Laura A E et al. “Next-Generation Sequencing: An Eye-Opener for the Surveillance of Antiviral Resistance in Influenza.” Trends in biotechnology vol. 38,4 (2020): 360-367.

Information Packet B7

You are a public communications expert, often employed by the Baltyre city council to manage the PR response to different initiatives or crises.

As a public communications expert, you are familiar with the literature surrounding science communication in a pandemic, including papers such as:

  • Matta, G. Science communication as a preventative tool in the COVID19 pandemic. Humanit Soc Sci Commun 7, 159 (2020).

  • Abdool Karim, Salim S. “Public understanding of science: Communicating in the midst of a pandemic.” Public understanding of science (Bristol, England) vol. 31,3 (2022): 282-287.

  • Royan, Regina et al. “Use of Twitter Amplifiers by Medical Professionals to Combat Misinformation During the COVID-19 Pandemic.” Journal of medical Internet research vol. 24,7 e38324. 22 Jul. 2022, doi:10.2196/38324

  • Tait, Margaret E et al. “Serving the public? A content analysis of COVID-19 public service announcements airing from March - December of 2020 in the U.S.” Preventive medicine reports vol. 29 (2022): 101971.

You have assembled the following information/resources for this meeting:

  • Influenza Pandemic Communication and Public Outreach (CDC)

  • Lawes-Wickwar, Sadie et al. “A Rapid Systematic Review of Public Responses to Health Messages Encouraging Vaccination against Infectious Diseases in a Pandemic or Epidemic.” Vaccines vol. 9,2 72. 20 Jan. 2021, doi:10.3390/vaccines9020072

  • Bielecki, K et al. “Impact of an influenza information pamphlet on vaccination uptake among Polish pupils in Edinburgh, Scotland and the role of social media in parental decision making.” BMC public health vol. 20,1 1381. 10 Sep. 2020, doi:10.1186/s12889-020-09481-z

Information Packet B8

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You are one of the doctors at the largest surgery in Baltyre. In the past fortnight, 97 of your patients have recently presented to the surgery with symptoms consistent with influenza. You have therefore recently been familiarising yourself with the relevant literature:

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You are one of the doctors at the largest surgery in Baltyre. In the past fortnight, 73 of your patients have recently presented to the surgery with symptoms consistent with influenza. You have therefore recently been familiarising yourself with the relevant literature:

>>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4

Information Packet B9

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You are an epidemiologist working at the University of Baltyre, and have been studying influenza A transmission dynamics for the past 6 years. As such, you are very familiar with the relevant literature, including papers such as:

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You are an epidemiologist working at the University of Baltyre, and have been studying influenza A transmission dynamics for the past 2 years. As such, you are very familiar with the relevant literature, including papers such as:

>>>>>>> a59875f3ebf67ebf397f9e4cede9dd2ddcad69c4

  • Castro-Sanguinetti GR, González-Veliz R, Callupe-Leyva A, et al. Highly pathogenic avian influenza virus H5N1 clade 2.3.4.4b from Peru forms a monophyletic group with Chilean isolates in South America. Sci Rep. 2024;14(1):3635. Published 2024 Feb 13. doi:10.1038/s41598-024-54072-2

  • Yang Q, Wang B, Lemey P, et al. Synchrony of Bird Migration with Global Dispersal of Avian Influenza Reveals Exposed Bird Orders. Nat Commun. 2024;15(1):1126. Published 2024 Feb 6. doi:10.1038/s41467-024-45462-1

  • Seo YR, Cho AY, Si YJ, et al. Evolution and Spread of Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4b Virus in Wild Birds, South Korea, 2022-2023. Emerg Infect Dis. 2024;30(2):299-309. doi:10.3201/eid3002.231274

  • Croville G, Walch M, Sécula A, et al. An amplicon-based nanopore sequencing workflow for rapid tracking of avian influenza outbreaks, France, 2020-2022. Front Cell Infect Microbiol. 2024;14:1257586. Published 2024 Jan 22. doi:10.3389/fcimb.2024.1257586

  • Wang X, Kim KW, Walker G, Stelzer-Braid S, Scotch M, Rawlinson WD. Genome characterization of influenza A and B viruses in New South Wales, Australia, in 2019: A retrospective study using high-throughput whole genome sequencing. Influenza Other Respir Viruses. 2024;18(1):e13252. doi:10.1111/irv.13252

  • Szablewski CM, McBride DS, Trock SC, et al. Evolution of influenza A viruses in exhibition swine and transmission to humans, 2013-2015. Zoonoses Public Health. Published online December 18, 2023. doi:10.1111/zph.13104

  • Perofsky AC, Huddleston J, Hansen C, et al. Antigenic drift and subtype interference shape A(H3N2) epidemic dynamics in the United States. Preprint. medRxiv. 2023;2023.10.02.23296453. Published 2023 Oct 3. doi:10.1101/2023.10.02.23296453